| Florida Endocrinology & Diabetes Center Llc | |
|
2763 1st Ave N St Petersburg FL 33713-8723 | |
| (727) 623-9913 | |
| (727) 803-4852 |
| Full Name | Florida Endocrinology & Diabetes Center Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2763 1st Ave N, St Petersburg, Florida |
| Authorized Official Name and Position | Venkata G Budharaju (OWNER) |
| Authorized Official Contact | 7276239913 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Florida Endocrinology & Diabetes Center Llc 2763 1st Ave N St Petersburg FL 33713-8723 Ph: (727) 623-9913 | Florida Endocrinology & Diabetes Center Llc 2763 1st Ave N St Petersburg FL 33713-8723 Ph: (727) 623-9913 |
| NPI Number | 1790123271 |
|---|---|
| Provider Enumeration Date | 06/06/2013 |
| Last Update Date | 02/16/2016 |
| Medicare PECOS PAC ID | 0941442172 |
|---|---|
| Medicare Enrollment ID | O20130816000667 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790123271 | NPI | - | NPPES |
| 008900700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | ME108425 (Florida) | Primary |
| Provider Name | Hossam Ibrahim |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1639168990 PECOS PAC ID: 3072425560 Enrollment ID: I20080623000562 |
| Provider Name | Venkata G Budharaju |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1427114735 PECOS PAC ID: 4587833652 Enrollment ID: I20110805000308 |
| Provider Name | Samantha L Sugarman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700334612 PECOS PAC ID: 6507147329 Enrollment ID: I20170110000076 |
| Provider Name | Stephanie P Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245720705 PECOS PAC ID: 9032457643 Enrollment ID: I20190206001732 |
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